Theories About Insanity

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Dr. Edouard Toulouse

Dr. Edouard Toulouse

Today’s newspapers very seldom discuss the actual causes of mental illness, but experts in the past were much more confident about their ability to dig out the reasons behind a patient’s problems. In 1922, The Washington Post ran an article in which a Professor Edouard Toulouse stated that there were three primary causes of madness: sorrow, thyroid deficiency, and vice.

Upon checking into his clinic, patients were interviewed, then given a physical exam to see whether they were born “with an excess of thyroid matter” or whether they had become addicts to vice, which included drugs. The good news was that Toulouse believed patients could be cured no matter how their madness originated.

Vice Was Considered A Cause of Insanity

Vice Was Considered A Cause of Insanity

Sorrow, of course, had many origins, but Dr. Toulouse particularly spoke about the difficulty of curing a patient whose sorrow derived from loss of wealth. He said that “practically the only sedative for a person who has once been wealthy and who finds himself suddenly poverty-stricken is to provide him again with wealth.” This course was often impossible, but diversion and time could be effective in healing.

Though Toulouse may have over-simplified the causes and treatments of insanity, his views gave patients’ families great hope. Toulouse firmly believed that nearly all cases of madness could be cured, which had to be comforting to a patient’s loved ones. Furthermore, he thought many cases of madness could be prevented, and said: “It remains now to coordinate our work so that prophylaxis [meaning the prevention of madness] will become legally obligatory.”

Good Mental Hygiene Was Recognized as a Way to Prevent Insanity

Good Mental Hygiene Was Recognized as a Way to Prevent Insanity

The article did not say what all these preventatives might be, but Dr. Toulouse was president of the Paris League for Mental Hygiene and Prophylaxis and surely had many programs and practices in mind. At least one primary avenue he and the League proposed was to stop sending patients immediately to an asylum, and instead assess their condition in a dispensary first and offer outpatient care in milder cases. This one step would likely have alleviated much sorrow and anxiety for patients and their families.

Goat Glands as Cure for Insanity

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J. R. Brinkley, from The Goat-Gland Transplantation

J. R. Brinkley, from The Goat-Gland Transplantation

The March 14, 1920 issue of the New York American carried an article about Dr. John Brinkley and some of his amazing cures through goat gland transplants. Brinkley had pioneered the use of these gland transplants to cure everything from barrenness in women to aging and hardening of the arteries. Goat gland transplants would also cure insanity, according to a case study discussed in a book: The Goat-Gland Transplantation by Sydney Flower.

A young woman suffering for the past twelve years with dementia praecox (a premature dementia, often beginning in the teens) that included homicidal tendencies and depression, had been treated by many specialists to no avail. However, Dr. Brinkley transplanted goat glands in her, and “the day after the transplantation of the glands this young woman embraced her mother, and talked so rationally to her that she called in Dr. Brinkley, and with tears repeated what her daughter had just said.”

The Dementia Praecox Case and Head Nurse Miss Lewis

The Dementia Praecox Case and Head Nurse Miss Lewis

Brinkley established the Brinkley-Jones Hospital and Training School for Nurses at Milford, Kansas, where he and other doctors performed thousands of goat gland operations. Brinkley had purchased his own medical diploma from Eclectic Medical University of Kansas City, Missouri, which was enough to allow him to operate as a surgeon for many years. Fortunately, Morris Fishbein, editor of the American Medical Association’s journal, finally forced Brinkley into court, where his fraudulent background and ignorance about medical matters became grounds to revoke his license.

Brinkley's Hospital in Milford, Kansas

Brinkley’s Hospital in Milford, Kansas

Predicting Madness

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Issue of the American Journal of Insanity

Issue of the American Journal of Insanity

“I am tempted sometimes to think that no person goes mad . . . who does not show more or less plainly, by his gait, manner, gestures, habits of thought, feeling and action that he is predestined to go mad.”

This quote (by a Professor Maudsley) in the October,1872 issue of the American Journal of Insanity, shows clearly that many noted psychiatrists–called alienists at the time–believed they could predict who might eventually go insane. Unfortunately, alienists had little ability to prevent this madness, beyond advising potential patients to avoid certain triggers that might bring it on. Such triggers included overwork, over-excitement, riotous living, worry, financial setbacks, grief, and so on.

Group of Prominent German Alienists

Group of Prominent German Alienists

Even more unfortunately, many alienists believed that insanity was rooted in physical causes that could be hereditary. This view had the potential to put anyone who had mental illness within the family in limbo, waiting to see if the illness would manifest. And because it was so often considered hereditary, having a family member with insanity was a barrier to marriage unless its cause could be positively attributed to an unusual circumstance like a blow to the head, sunstroke, or other purely physical cause.

This Eugenics Certificate Shows the Public's Fear of Undesirable Hereditary Traits, courtesy Robert Bogdan Collection

This Eugenics Certificate Shows the Public’s Fear of Undesirable Hereditary Traits, courtesy Robert Bogdan Collection

It is certainly sad to think that many people waited and worried their entire lives over an issue that had no potential to materialize.

Happier at Home

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The Invalid, circa 1870, by Louis Lang is Highly Idealized

The Invalid, circa 1870, by Louis Lang is Highly Idealized

Most people today don’t enjoy staying in hospitals, and this was doubly true for people in the 1800s. Doctors were not held in high esteem, and neither medical knowledge nor the primitive equipment/technology available were particularly reassuring. Well into the early 1900s, many ordinary people considered hospitals more a place to die than a place to recover.

Instead, home care was the norm, and hospitals were often seen as a last resort for patients without family and friends to care for them. (This is a general statement, of course, and certainly people did go to hospitals with excellent outcomes.) Rather than relying on professional staff, most families expected mothers, sisters, and wives to “nurse” anyone in the family who was ill. Between a doctor’s visit, a few herbs and traditional concoctions, and a consultation with a home medical manual, most families coped well enough with the situations that came their way.

Dr. Thomas Riddle in the 1920s

Dr. Thomas Riddle in the 1920s

Mental health care was different. No one–including doctors–really understood it or knew how to treat it. Consequently, the mentally ill were often neglected. Some families were ashamed of their sick relative and hid him or her away in the traditional attic described in many a melodramatic tale. Other families beat or starved their insane members out of ignorance or exasperation, or turned them out entirely if their behavior became too difficult to handle. Actually treating mental illness with a hope for recovery was nearly impossible in the home.

A Doctor Checking on a Patient, 1800s

A Doctor Checking on a Patient, 1800s

As medical knowledge increased, the idea of “hospitals for the insane” became more acceptable. This blog and the book I’m working on will give information about the early years of psychiatry and its most visible symbol: the insane asylum.